Review the R’s of your volunteer program
Programs provide meaningful experience
The importance of volunteers in a hospice program is undeniable. Without them, a hospice would have difficulty meeting the basic needs of its patients or it would go bankrupt trying. With that in mind, hospices would be well-served to review their recruiting, training, and retention efforts, to ensure the long-term success of their volunteer programs.
According to experts, hospice volunteer programs require regular review and updating. Specifically, they should focus on:
• Recruitment. Attracting motivated individuals who fill specific needs within the hospice, including direct patient care, bereavement services, fundraising, and administration.
• Retention. Providing meaningful experiences and support for volunteers to keep them interested serving hospice.
• Training. Proving educational programs that educate volunteers on the hospice philosophy and clearly illustrate appropriate interaction between patient and volunteer, and family members and volunteer.
• Recognition. Showing appreciation for the work of volunteers both as an individual and as a group.
Attracting volunteers can be tricky for some hospices. Most hospice volunteers have had someone close to them benefit from hospice care. While grateful families can provide a well of potential volunteers, hospices run the risk of staffing their volunteer ranks with those using the experience to work through grief issues of their own. In most cases, hospices do not allow family and friends of recent hospice patients to volunteer until after a year has passed since the death of their loved one. That puts some pressure to recruit volunteers who know little of hospice or those who might be apprehensive about caring for the dying.
One recruiting challenge is a simple matter of geography. Depending on the location of a hospice, the challenges can vary. Hospice of Washington in Washington, DC, for example, competes with a wide variety of volunteer opportunities available in the nation’s capital and surrounding communities.
"People can volunteer at the White House," says Karen Jones, senior director of community relations and the hospice’s former director of volunteer services. "Being in Washington means there is a lot of competition for volunteers’ time. So you have to provide something that is meaningful."
Hospices in rural areas, such as the Hospice of Central Iowa in Des Moines, covering a 19-county area, must find volunteers in the smaller surrounding communities to meet the needs of patients who are too far for urban-based volunteers to reach.
"When you cover a metropolitan area like Des Moines — there really isn’t a metropolitan area, it’s all pretty rural — your approach needs to be different," says Ann Cochran, volunteer coordinator for the Hospice of Central Iowa.
There are the typical approaches to attracting volunteers — using available public service announcement spots on local television and in newspapers — but recruitment requires more than that shotgun approach.
Hospice of Washington uses its programs to attract volunteers. "If you have interesting programs, you will automatically have people eager to participate," Jones says.
To enhance the appeal of their programs, Hospice of Washington set out to create volunteer programs that touch upon a number of alternative therapies, services that many of its patients and families would benefit from, such as massage therapy. The idea is that by providing cutting-edge therapies, volunteers would be eager to participate.
It’s a departure from the traditional approach to recruiting volunteers: taking potential volunteers and matching them to needs that exist within the hospice, including direct patient care.
Instead, Hospice of Washington developed outreach programs in which volunteers could apply their unique skills or explore burgeoning interests. For example, the hospice created an AIDS outreach program that involves a number of alternative therapies provided by volunteers. It also organized weekend retreats for its patients at nearby resorts where volunteers provide the bulk of care in a vacation setting. This doesn’t mean it don’t actively try to fill traditional volunteer needs, but its outreach programs reach those who may not have considered volunteering at its hospice.
"It hasn’t been a problem recruiting," says Sherry Peach, director of volunteer services at Hospice of Washington. "It’s actually worked out beautifully. Not only do the patients get a massage therapist, for example, but they also get a friend who will talk with them and hold their hand."
Hospice of Central Iowa has more traditional needs, but must meet them by treating each small community individually, says Cochran. While TV and newspaper ads successfully bring in volunteers within Des Moines and contiguous counties, filling the needs within small towns is challenging.
In those areas, Cochran relies on truly old-fashioned techniques. Church bulletins and small town publications advertise Hospice of Central Iowa’s need for volunteers. Because churches, coffee shops, and taverns are traditional gathering places in small towns, she is assured her call for volunteers will be seen by rural residents.
Often, these small communities — where a premium is placed on helping neighbors — take on the care of hospice patients as a community project, Cochran says.
Another recruiting challenge is convincing people that there is a place for their skills even if patient care isn’t what interests them. "Anyone that wants to volunteer, you can find a place for them," says Cochran. "It’s a matter of matching their skills and interests to your needs."
Teach the hospice’s philosophy
Once the volunteers have been brought into the program, hospices need to have a curriculum in place that readies volunteers for their assignment. Part of that preparation, experts say, is for volunteers to be schooled in the hospice’s mission.
"Everyone should be familiar with the hospice philosophy," says Cochran.
Fulfilling this requirement takes more than a few simple statements read by hospice employees or a couple of inservice sessions. Hospices need to develop a program that exposes volunteers to the interdisciplinary team approach to care and teaches volunteers’ role on the team.
Traditionally, hospices approach this task by holding a series of one- to three-hour sessions during the week at a time convenient to most volunteers. Hospice of Washington officials don’t think that’s enough, and recommend a program that immerses volunteers in hospice education over a shorter, but intense, period.
"I bet I would be hard-pressed to find people who didn’t have to miss a session," says Jones. "I don’t think having volunteers for a couple of nights a week is comprehensive."
The problem with the consecutive-series approach, Jones says, is that they allow opportunity for volunteers to miss sessions because of competing demands, including family and work obligations.
At Hospice of Washington, volunteers are required to give two full Saturdays to training sessions. The training program covers:
• the hospice’s mission;
• the hospice’s concept (the key features of the benefit, including palliative care over curative care);
• the medical perspective (interdisciplinary team approach and specific pain management methods);
• grief and bereavement;
• caring for the family;
• patient care techniques;
• administrative requirements (documentation and confidentiality).
After the volunteers complete the training program, they are assigned a mentor, an experienced volunteer. The volunteer follows his or her mentor during patient care for nine to 12 hours before deciding which area they want to volunteer.
Cochran says it is important for volunteers to work through their own feelings of death and grief. To do so, she recommends volunteers first be taught the signs and symptoms of dying and then understand their role when the patient shows those signs.
If a patient refuses to eat or drink, for example, the volunteer is told that those are signs of the body shutting down. Rather than intervening because food and water are basic needs, the volunteer understands the patient’s body is preparing to die.
Yet the idea of allowing someone to refuse basic needs may be hard for some people. That’s why Cochran has included a group discussion about death and dying into the training program at the Hospice of Central Iowa.
The group discussion allows volunteers to get in touch with their own views on death and dying and allows them to relate it to the hospice’s mission. More importantly, they learn that their views should not be imposed on those they are trying to help.
"They have to be rooted in the fact that we provide comfort, not a cure, and understand why," Cochran said. "It’s really important that boundaries don’t get blurred. You have to make sure volunteers have worked out their own loss issues."
To reinforce those ideas, the group discussion includes exercises where the group tackles hypothetical situations and discuss right and wrong behavior. "We teach respect for different views and show them that it is normal for a dying patient not to want to eat," Cochran adds.
Because a hospice has invested its resources in recruiting and training, it wants to be sure volunteers remain with the program. Of course, attrition will occur naturally, volunteers move away, change jobs, and family demands change. What hospices want to avoid are volunteers who burn out or become disillusioned.
At the heart of all this, Cochran says, is making volunteers feel appreciated and that their work makes a difference. At Hospice Atlanta, Barbara Moore, manager of volunteer services, says she makes an effort to speak with volunteers individually.
Because volunteers are required to undergo annual tuberculosis screenings, Moore says she uses the opportunity to meet with volunteers to ask them about their volunteer experience and thank them individually for their effort.
She also warns against demanding too much from volunteers. With growing needs, it’s easy to keep asking the same volunteers to pitch in without taking into account their need for personal time.
"Don’t let anyone feel guilty because they can’t give more time," Moore says.